Prophylaxis of postoperative nausea and vomiting with ondansetron, metoclopramide, or placebo in total intravenous anesthesia patients undergoing laparoscopic cholecystectomy

OBJECTIVE: To compare total intravenous anesthesia (TIVA) with ondansetron, and metoclopramide in preventing postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy patients.

METHODS: A prospective randomized double-blinded study was performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia in 2007. Seventy-five patients scheduled for laparoscopic cholecystectomy under TIVA were randomized to receive either: metoclopramide 10 mg (n=25), 4 mg ondansetron (n=25), or placebo (n=25) at the end of surgery. Postoperative nausea and vomiting episodes, analgesic supply, rescue medication, adverse events, and patient satisfaction were collected over 24 hours.

RESULTS: Nineteen patients developed PONV. The frequencies of PONV were equal for the 2 groups (28%), and lower among the ondansetron group (20%) (p>0.05). Female gender, lengthy surgery, and longer hospital stay were associated with more frequent PONV regardless of the study group (p<0.05). Patient's satisfaction was more frequent among the ondansetron group (p>0.05). Morphine consumption was associated with more PONV, but it was statistically significant only in the placebo group. There was no difference between the 3 groups with regard to the VAS pain score, cardiovascular parameters, or oxygen saturation.

CONCLUSION: It is unlikely that a single technique or drug will ever be effective in treating emesis under all surgical circumstances. Therefore, a multimodal regimen incorporating avoidance of emesis triggering factors, and administration of antiemetic medications is recommended.